# Optimizing Psychotherapy for Older Veterans with Chronic Pain

> **NIH VA IK2** · VA GREATER LOS ANGELES HEALTHCARE SYSTEM · 2021 · —

## Abstract

The overarching goal of the proposed research is to learn how to optimize psychotherapy for those Veterans
most in need and most likely to benefit from psychotherapy, older Veterans with chronic musculoskeletal pain.
Chronic pain is a critical healthcare challenge, as the condition affects 50% of all Veterans and affects older
Veterans most commonly, severely, and persistently. For years, chronic pain treatment has been notoriously
difficult at VA and elsewhere, especially in light of the recent “opioid crisis,” in which opioid analgesics,
previously a mainstay of chronic pain treatment, have come under increased scrutiny. In response, CDC,
VA/DoD, and some experts have called for enhancing and expanding psychosocial treatment options for
chronic pain, such as psychotherapy, which are low risk for older Veterans who frequently have multiple
medical comorbidities and are taking multiple medications.
Yet standard VA psychotherapy approaches, such as Cognitive Behavior Therapy (CBT), have shown modest
benefits for Veterans on pain and other related patient-centered outcomes (PCO), such as mood, anxiety, and
sleep. In contrast, a novel psychotherapy approach, Emotional Awareness and Expression Therapy (EAET),
has shown medium to large benefits for some chronic pain patients. Whereas CBT improves pain and
negative emotion by teaching patients cognitive and behavioral coping skills, affecting brain regions
that enhance “cognitive control” of pain, EAET operates primarily through emotion regulation, which is
thought to influence brain regions and circuits that modulate both physical pain and emotion—a
mechanism absent from existing approaches. The literature and our pilot data indicate that patients
who express a significant amount of emotional distress at baseline, such as high anxiety and
depressive symptoms, may be particularly likely to benefit from EAET’s emotion regulation approach,
whereas patients who express less emotional distress may derive more benefit from an approach like
CBT, which does not require ready access to emotions.
The proposed randomized clinical trial tests the hypothesis that EAET is superior to CBT on reduction in mean
pain severity and other PCO (derived from IMMPACT recommendations). To examine which patients are most
likely to benefit, this research also tests whether greater baseline emotional distress (using measures of
anxiety and depression) predicts stronger benefits from EAET and whether lower baseline emotional
distress predicts stronger benefits from CBT. Finally, this research explores whether the benefits of
EAET are mediated by improved emotion regulation (using measures of ambivalence over emotional
expression and emotional approach coping), the benefits of CBT are mediated by improved cognitive
and behavioral coping (using measures of pain catastrophizing and adaptive coping), and whether the
benefits of both are mediated by a stronger working alliance. We plan to enroll 160 multi-ethnic/multi-
racial older Ve...

## Key facts

- **NIH application ID:** 9920003
- **Project number:** 5IK2CX001884-02
- **Recipient organization:** VA GREATER LOS ANGELES HEALTHCARE SYSTEM
- **Principal Investigator:** Brandon C Yarns
- **Activity code:** IK2 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-04-01 → 2024-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9920003

## Citation

> US National Institutes of Health, RePORTER application 9920003, Optimizing Psychotherapy for Older Veterans with Chronic Pain (5IK2CX001884-02). Retrieved via AI Analytics 2026-05-21 from https://api.ai-analytics.org/grant/nih/9920003. Licensed CC0.

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